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Spampinato G, Candeliere F, Amaretti A, Paris R, Montanari M, Virzì N, Strani L, Citti C, Cannazza G, Rossi M, Raimondi S. A three-years survey of microbial contaminants in industrial hemp inflorescences from two Italian cultivation sites. J Cannabis Res 2024; 6:31. [PMID: 39020444 PMCID: PMC11253326 DOI: 10.1186/s42238-024-00241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/07/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The use of industrial Cannabis sativa L. for recreational, cosmeceutical, nutraceutical, and medicinal purposes has gained momentum due to its rich content of valuable phytochemicals, such as cannabidiol (CBD) and cannabigerol (CBG). However, there are concerns regarding the risk of microbial contamination in plants grown outside controlled environments. Microbes associated with hemp can be either epiphytes or endophytes and may pose a risk of infectious illness for humans. METHODS Seven Italian hemp genotypes, including Bernabeo, Carmagnola, Carmaleonte, Codimono, CS, Eletta Campana, and Fibranova, were cultivated in two distinct geographic locations, Catania and Rovigo, for three consecutive years from 2019 to 2021. Total aerobic microbes (TAMC), total combined yeasts/moulds (TYMC), the presence of bile-tolerant Gram-negative bacteria, and the absence of Escherichia coli and Salmonella spp. were evaluated and compared. The main phytocannabinoid content was measured and correlated with microbial contamination. RESULTS Most samples analyzed in this study did not meet the European Pharmacopoeia microbiological limits. The detection of potential pathogens, such as E. coli and Salmonella spp., in the samples indicates that the use of inflorescences may represent a possible source of infection. Microbial contamination varied among harvesting seasons and production sites, with agroclimatic conditions influencing microbial load and composition. The presence of potentially pathogenic bacteria was less associated with seasonal climate variability and more likely affected by sporadic contamination from external sources. CBD concentration exhibited a negative correlation with bile-tolerant Gram-negative bacteria and total yeasts/moulds levels. Samples with lower CBD content were more contaminated than those with higher CBD levels, suggesting a potential protective effect of this phytochemical on the plant. CONCLUSIONS The threshing residues (inflorescences, floral bracts, and leaves) of industrial hemp varieties represent a valuable product and a source of beneficial phytochemicals that warrants further exploration. While post-harvest sterilization methods may reduce microbiological risks, they may also degrade heat- and light-sensitive bioactive phytochemicals. The most promising strategy involves implementing best agronomic practices to maintain healthy and uncontaminated cultures. Rigorous monitoring and quality certification protocols are essential to mitigate the microbiological risk associated with the consumption of hemp-derived products.
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Affiliation(s)
- Gloria Spampinato
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Francesco Candeliere
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Alberto Amaretti
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Roberta Paris
- CREA Research Centre for Cereal and Industrial Crops, Via Di Corticella 133, 40128, Bologna, Italy
| | - Massimo Montanari
- CREA Research Centre for Cereal and Industrial Crops, Via Di Corticella 133, 40128, Bologna, Italy
| | - Nino Virzì
- CREA Research Centre for Cereal and Industrial Crops, C.So Savoia 190, 95024, Acireale, CT, Italy
| | - Lorenzo Strani
- Department of Chemical and Geological Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Cinzia Citti
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Giuseppe Cannazza
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
| | - Maddalena Rossi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Stefano Raimondi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, 41125, Modena, Italy.
- Biogest-Siteia, University of Modena and Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
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Pedrosa AM, Caetano TTV, Andrade CMLD, Bernardes MM, Alves BC, Belo V, Duarte-Almeida JM, Stein VC. Cannabis sativa L. from Seized Drug Material: In Vitro Germination and Establishment. Cannabis Cannabinoid Res 2024; 9:e924-e932. [PMID: 37729052 DOI: 10.1089/can.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background: With the expansion of the cannabis-derived product market, there is a growing need for seedling development to produce raw material for pharmaceutical applications and medicinal research. However, cannabis cultivation is illegal in many countries, and legal producers do not sell cannabis seeds in these countries. In Brazil, cannabis is still illegal, and the only way to obtain access to cannabis plants for research or as medicine is through importation, which is costly and requires authorization from the National Health Surveillance Agency (ANVISA), or from material seized by the police from drug trafficking. Methods: Therefore, since cannabis seeds obtained from drug trafficking have never been tested regarding their viability and use in in vitro cultivation, the aim of this study was to analyze the in vitro establishment of cannabis from seeds derived from Brazilian drug trafficking seizures that were provided by the police to investigate seed disinfestation procedures and further multiplication of nodal segments, with the purpose of obtaining material for medicinal research in the country. Seeds were subjected to four disinfestation treatments. Results: The best disinfestation treatment consisted in submerging the seeds in a 2 g·L-1 Captan® solution for 30 min before following the standard procedure with 70% ethanol for 30 sec and then 20 min in 2.5% sodium hypochlorite. The in vitro establishment of cannabis from seeds originating from Brazilian drug trafficking seizures was successful. The germination rate ranged from 10% to 90% according to the sample material. Non-brick weed, which consisted of dry leaves, stalks, and flowers, was more suitable for seed extraction and germination. Clones originating from BW4b showed the best development results compared with others. Conclusions: This is the first report of in vitro cannabis use in Brazil and opens great prospects for future work on its cultivation and research for medicinal applications in the country without relying on seed importation.
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Affiliation(s)
- Alessandra Moraes Pedrosa
- Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | | | | | | | - Bruna Cristina Alves
- Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | - Vinícius Belo
- Federal University of São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, Minas Gerais, Brazil
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Moore A, Straube S, Fisher E, Eccleston C. Cannabidiol (CBD) Products for Pain: Ineffective, Expensive, and With Potential Harms. THE JOURNAL OF PAIN 2024; 25:833-842. [PMID: 37863344 DOI: 10.1016/j.jpain.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
Cannabidiol (CBD) attracts considerable attention for promoting good health and treating various conditions, predominantly pain, often in breach of advertising rules. Examination of available CBD products in North America and Europe demonstrates that CBD content can vary from none to much more than advertised and that potentially harmful other chemicals are often included. Serious harm is associated with chemicals found in CBD products and reported in children, adults, and the elderly. A 2021 International Association for the Study of Pain task force examined the evidence for cannabinoids and pain but found no trials of CBD. Sixteen CBD randomized trials using pharmaceutical-supplied CBD or making preparations from such a source and with pain as an outcome have been published subsequently. The trials were conducted in 12 different pain states, using 3 oral, topical, and buccal/sublingual administration, with CBD doses between 6 and 1,600 mg, and durations of treatment between a single dose and 12 weeks. Fifteen of the 16 showed no benefit of CBD over placebo. Small clinical trials using verified CBD suggest the drug to be largely benign; while large-scale evidence of safety is lacking, there is growing evidence linking CBD to increased rates of serious adverse events and hepatotoxicity. In January 2023, the Food and Drug Administration (FDA) announced that a new regulatory pathway for CBD was needed. Consumers and health care providers should rely on evidence-based sources of information on CBD, not just advertisements. Current evidence is that CBD for pain is expensive, ineffective, and possibly harmful. PERSPECTIVE: There is no good reason for thinking that CBD relieves pain, but there are good reasons for doubting the contents of CBD products in terms of CBD content and purity.
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Affiliation(s)
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Claverton Down, Bath, UK
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Kale R, Chaturvedi D, Dandekar P, Jain R. Analytical techniques for screening of cannabis and derivatives from human hair specimens. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:1133-1149. [PMID: 38314866 DOI: 10.1039/d3ay00786c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Cannabis and associated substances are some of the most frequently abused drugs across the globe, mainly due to their anxiolytic and euphorigenic properties. Nowadays, the analysis of hair samples has been given high importance in forensic and analytical sciences and in clinical studies because they are associated with a low risk of infection, do not require complicated storage conditions, and offer a broad window of non-invasive detection. Analysis of hair samples is very easy compared to the analysis of blood, urine, and saliva samples. This review places particular emphasis on methodologies of analyzing hair samples containing cannabis, with a special focus on the preparation of samples for analysis, which involves screening and extraction techniques, followed by confirmatory assays. Through this manuscript, we have presented an overview of the available literature on the screening of cannabis using mass spectroscopy techniques. We have presented a detailed overview of the advantages and disadvantages of this technique, to establish it as a suitable method for the analysis of cannabis from hair samples.
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Affiliation(s)
- Rohit Kale
- Department of Biological Sciences and Biotechnology, Institute of Chemical Technology, Mumbai 400019, India.
| | - Deepa Chaturvedi
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India.
| | - Prajakta Dandekar
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India.
| | - Ratnesh Jain
- Department of Biological Sciences and Biotechnology, Institute of Chemical Technology, Mumbai 400019, India.
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Dassieu L, Paul-Savoie E, Develay É, Villela Guilhon AC, Guénette L, Perreault K, Beaudry H, Dupuis L, Audet C, Lacasse A. Experiences and Perceptions of Medical Cannabis among People Living with Chronic Pain and Community Pharmacists: A Qualitative Study in Canada. Can J Pain 2023; 7:2258537. [PMID: 38027232 PMCID: PMC10653616 DOI: 10.1080/24740527.2023.2258537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023]
Abstract
Background The use of cannabis to treat chronic pain is under debate despite high expectations from patients. Qualitative data obtained by exploring both patients' and health professionals' perspectives are scarce. Aims This study aimed to understand the experiences and perceptions of people living with chronic pain and community pharmacists regarding the role of cannabis in chronic pain treatment in the Canadian context where both medical and recreational cannabis are legal. Methods We conducted 12 online focus groups (July 2020-February 2021) with 26 patients and 19 community pharmacists using semistructured discussion guides. All discussions were audio recorded and transcribed verbatim were analyzed using a reflexive thematic approach. Results We developed three themes related to patients' perspectives and three themes related to pharmacists' perspectives. Patients' perspectives included (1) cannabis as an alternative to other pain medications, (2) a new treatment with potential health-related risks, and (3) a therapy rather than a recreational drug. Pharmacists' perspectives included (1) challenges in monitoring drug interactions with cannabis in the context of scarce research data, (2) informing and treating patients self-medicating with cannabis amid its growing popularity, and (3) financial costs and legal constraints for patients. Conclusions This study highlights patients' and pharmacists' urgent need for reliable information regarding the benefits and risks of cannabis. Training tailored to pharmacists' needs and evidence-based information for patients should be developed to support pharmacists' practice, improve patients' experiences, and promote safe cannabis use.
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Affiliation(s)
- Lise Dassieu
- Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Emilie Paul-Savoie
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Élise Develay
- Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Ana Cecilia Villela Guilhon
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Line Guénette
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHU de Québec, Université Laval, Axe Santé des populations et pratiques optimales en santé, Quebec City, Quebec, Canada
| | - Kadija Perreault
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Hélène Beaudry
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Laurent Dupuis
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
| | - Claudie Audet
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Anaïs Lacasse
- Quebec Pain Research Network, Sherbrooke, Quebec, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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6
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Chandwani B, Bradley BA, Pace A, Buse DC, Singh R, Kuruvilla D. The Exploration of Cannabis and Cannabinoid Therapies for Migraine. Curr Pain Headache Rep 2023; 27:339-350. [PMID: 37515745 DOI: 10.1007/s11916-023-01144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW There is increasing interest in the use of cannabis and cannabinoid therapies (CCT) by the general population and among people with headache disorders, which results in a need for healthcare professionals to be well versed with the efficacy and safety data. In this manuscript, we review cannabis and cannabinoid terminology, the endocannabinoid system and its role in the central nervous system (CNS), the data on efficacy, safety, tolerability, and potential pitfalls associated with use in people with migraine and headache disorders. We also propose possible mechanisms of action in headache disorders and debunk commonly held myths about its use. RECENT FINDINGS Preliminary studies show that CCT have evidence for the management of migraine. While this evidence exists, further randomized, controlled studies are needed to better support its clinical use. CCT can be considered an integrative treatment added to mainstream medicine for people with migraine who are refractory to treatment and/or exhibit disability and/or interest in trying these therapies. Further studies are warranted to specify appropriate formulation, dosage, and indication(s). Although not included in guidelines or the AHS 2021 Consensus Statement on migraine therapies, with the legalization of CCT for medical or unrestricted use across the USA, recent systematic reviews highlighting the preliminary evidence for its use in migraine, it is vital for clinicians to be well versed in the efficacy, safety, and clinical considerations for their use. This review provides information which can help people with migraine and clinicians who care for them make mutual, well-informed decisions on the use of cannabis and cannabinoid therapies for migraine based on the existing data.
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Affiliation(s)
- Brijesh Chandwani
- Department of Diagnostic Sciences, Tufts University, 1 Kneeland St, Boston, MA, 02111, USA.
- Attending, Orofacial Pain Service, St. Barnabas Hospital, Bronx, NY, USA.
| | | | - Anna Pace
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
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Fernández S, Castro R, López-Radcenco A, Rodriguez P, Carrera I, García-Carnelli C, Moyna G. Beyond cannabinoids: Application of NMR-based metabolomics for the assessment of Cannabis sativa L. crop health. FRONTIERS IN PLANT SCIENCE 2023; 14:1025932. [PMID: 37035042 PMCID: PMC10075229 DOI: 10.3389/fpls.2023.1025932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
While Cannabis sativa L. varieties have been traditionally characterized by their major cannabinoid profile, it is now well established that other plant metabolites can also have physiological effects, including minor cannabinoids, terpenes, and flavonoids. Given the multiple applications of cannabis in the medical field, it is therefore critical to characterize it according to its chemical composition (i.e., its metabolome) and not only its botanical traits. With this in mind, the cannabinoid and metabolomic profiles from inflorescences of two C. sativa varieties with either high Δ9-tetrahydrocannabinolic acid (THCA) or high cannabidiolic acid (CBDA) contents harvested at different times were studied. According to results from HPLC and NMR-based untargeted metabolomic analyses of organic and aqueous plant material extracts, we show that in addition to expected variations according to cannabinoid profiles, it is possible to distinguish between harvests of the same variety. In particular, it was possible to correlate variations in the metabolome with presence of powdery mildew, leading to the identification of molecular markers associated with this fungal infection in C. sativa.
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Affiliation(s)
- Santiago Fernández
- Laboratorio de Farmacognosia y Productos Naturales, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Rossina Castro
- Laboratorio de Farmacognosia y Productos Naturales, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Andrés López-Radcenco
- Laboratorio de Fisicoquímica Orgánica, Departamento de Química del Litoral, Centro Universitario Regional Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Paula Rodriguez
- Laboratorio de Biocatálisis y Biotransformaciones, Departamento de Química Orgánica and Departamento de Biociencias, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Inés Carrera
- Laboratorio de Experimentación Animal – Área Farmacología, Departamento de Ciencias Farmacéuticas, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Carlos García-Carnelli
- Laboratorio de Farmacognosia y Productos Naturales, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Guillermo Moyna
- Laboratorio de Fisicoquímica Orgánica, Departamento de Química del Litoral, Centro Universitario Regional Litoral Norte, Universidad de la República, Paysandú, Uruguay
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Corso B, Bacle A, Demay E, Mercerolle M, Pelletier R, Gicquel T, Le Daré B. Place of therapeutic cannabis in France and safety data: A literature review. ANNALES PHARMACEUTIQUES FRANÇAISES 2023:S0003-4509(23)00021-4. [PMID: 36841395 DOI: 10.1016/j.pharma.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To date, very few cannabis-based specialities are authorised on the French market despite a growing demand from patients and health professionals. The objective of this study is to review the tolerance profile and the French legislative status of the two main cannabinoids used for therapeutic purposes: tetrahydrocannabiol (THC) associated with psychoactive effects and non-psychoactive cannabidiol (CBD). METHODS This review is based on relevant articles retrieved by a search in Google Scholar and PubMed databases and on an assessment of the legal texts and summaries of product characteristics available in France. RESULTS Evidence for the tolerability of CBD during chronic use is reassuring, but a significant risk of drug interactions exists. THC use appears to be associated with a higher proportion of serious adverse effects, including neuropsychological and cardiovascular effects. Inhaled cannabis appears to be associated with greater toxicity than the oral route. These data are presented together with the pharmacokinetic and pharmacodynamic data of THC and CBD. CONCLUSION The literature reports several frequent but rarely serious adverse effects of CBD during chronic use as well as a significant risk of drug interactions. THC use seems to be associated with a higher proportion of serious adverse effects compared to CBD, particularly at the neuropsychological and cardiovascular levels. Health professionals should be up to date on the particularities of therapeutic cannabis in terms of efficacy, safety and drug interactions.
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Affiliation(s)
- B Corso
- Université de Rennes 1, 35000 Rennes, France
| | - A Bacle
- Service pharmacie, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - E Demay
- Service pharmacie, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - M Mercerolle
- Service pharmacie, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - R Pelletier
- Centre hospitalier universitaire de Rennes, laboratoire de toxicologie biologique et médico-légale, biochimie-toxicologie, 35000 Rennes, France; Université Rennes, Inserm, INRAE, CHU de Rennes, Institut NuMeCan (Nutrition, Métabolismes et Cancer), Réseau PREVITOX, 35000 Rennes, France
| | - T Gicquel
- Centre hospitalier universitaire de Rennes, laboratoire de toxicologie biologique et médico-légale, biochimie-toxicologie, 35000 Rennes, France; Université Rennes, Inserm, INRAE, CHU de Rennes, Institut NuMeCan (Nutrition, Métabolismes et Cancer), Réseau PREVITOX, 35000 Rennes, France
| | - B Le Daré
- Service pharmacie, centre hospitalier universitaire de Rennes, 35000 Rennes, France; Université Rennes, Inserm, INRAE, CHU de Rennes, Institut NuMeCan (Nutrition, Métabolismes et Cancer), Réseau PREVITOX, 35000 Rennes, France.
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10
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Luz-Veiga M, Azevedo-Silva J, Fernandes JC. Beyond Pain Relief: A Review on Cannabidiol Potential in Medical Therapies. Pharmaceuticals (Basel) 2023; 16:155. [PMID: 37259306 PMCID: PMC9958812 DOI: 10.3390/ph16020155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 07/30/2023] Open
Abstract
The phytocannabinoid cannabidiol (CBD) is receiving increasing attention due to its pharmacological properties. Although CBD is extracted from Cannabis sativa, it lacks the psychoactive effects of Δ9-tetrahydrocannabinol (THC) and has become an attractive compound for pharmacological uses due to its anti-inflammatory, antioxidant, anticonvulsant, and anxiolytic potential. The molecular mechanisms involved in CBD's biological effects are not limited to its interaction with classical cannabinoid receptors, exerting anti-inflammatory or pain-relief effects. Several pieces of evidence demonstrate that CBD interacts with other receptors and cellular signaling cascades, which further support CBD's therapeutic potential beyond pain management. In this review, we take a closer look at the molecular mechanisms of CBD and its potential therapeutic application in the context of cancer, neurodegeneration, and autoimmune diseases.
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Affiliation(s)
- Mariana Luz-Veiga
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João Azevedo-Silva
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - João C. Fernandes
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
- Amyris Bio Products Portugal, Unipessoal Lda, 4169-005 Porto, Portugal
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11
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Jameson LE, Conrow KD, Pinkhasova DV, Boulanger HL, Ha H, Jourabchian N, Johnson SA, Simeone MP, Afia IA, Cahill TM, Orser CS, Leung MC. Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:97001. [PMID: 36102653 PMCID: PMC9472674 DOI: 10.1289/ehp11206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The presence of contaminants in cannabis presents a potential health hazard to recreational users and susceptible patients with medical conditions. Because of the federally illegal status of cannabis, there are no unified regulatory guidelines mitigating the public health risk of cannabis contaminants. OBJECTIVE To inform further research and provide solutions to the public health risk of cannabis contaminants at a national level, we examined the current landscape of state-level contaminant regulations, and cannabis contaminants of concern, as well as patient populations susceptible to contaminants. METHODS We examined the regulatory documents for medical and recreational cannabis in all legalized U.S. jurisdictions and compiled a complete list of regulated contaminants, namely, pesticides, inorganics, solvents, microbes, and mycotoxins. We data mined the compliance testing records of 5,654 cured flower and 3,760 extract samples that accounted for ∼6% of California's legal cannabis production in 2020-2021. We also reviewed the publicly available medical cannabis use reports to tabulate the susceptible patient populations. RESULTS As of 18 May 2022, 36 states and the District of Columbia listed a total of 679 cannabis contaminants as regulated in medical or recreational cannabis, including 551 pesticides, 74 solvents, 12 inorganics, 21 microbes, 5 mycotoxins, and 16 other contaminants. Different jurisdictions showed significant variations in regulated contaminants and action levels ranging up to four orders of magnitude. A failure rate of 2.3% was identified for flowers and 9.2% for extracts in the California samples. Insecticides and fungicides were the most prevalent categories of detected contaminants, with boscalid and chlorpyrifos being the most common. The contaminant concentrations fell below the regulatory action levels in many legalized jurisdictions, indicating a higher risk of contaminant exposure. Cannabis use reports indicated usage in several patient populations susceptible to contamination toxicity, including cancer (44,318) and seizure (21,195) patients. DISCUSSION Although individual jurisdictions can implement their policies and regulations for legalized cannabis, this study demonstrates the urgent need to mitigate the public health risk of cannabis contamination by introducing national-level guidelines based on conventional risk assessment methodologies and knowledge of patients' susceptibility in medical use. https://doi.org/10.1289/EHP11206.
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Affiliation(s)
- Laura E. Jameson
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Kendra D. Conrow
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Dorina V. Pinkhasova
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Pharmacology and Toxicology Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | - Haleigh L. Boulanger
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Biological Data Science Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | - Hyunji Ha
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
- Biological Data Science Program, New College of Interdisciplinary Arts and Sciences, ASU, Glendale, Arizona, USA
| | | | | | | | | | - Thomas M. Cahill
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
| | - Cindy S. Orser
- ASU Library Data Science and Analytics, ASU, Tempe, Arizona, USA
| | - Maxwell C.K. Leung
- School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University (ASU), Glendale, Arizona, USA
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12
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Hallinan CM, Eden E, Graham M, Greenwood LM, Mills J, Popat A, Truong L, Bonomo Y. Over the counter low-dose cannabidiol: A viewpoint from the ACRE Capacity Building Group. J Psychopharmacol 2022; 36:661-665. [PMID: 34344208 DOI: 10.1177/02698811211035394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Amidst growing global acceptance of medicinal cannabinoids as a potential therapeutic interest in cannabidiol (CBD) is increasing. In Australia in 2020, a government inquiry examined the barriers that the public are experiencing in accessing medicinal cannabis. A number of recommendations to improve access were made. In response to these recommendations, the Australian therapeutics regulatory authority down-scheduled CBD from Prescription Only (Schedule 4) to Pharmacist Only (Schedule 3). As a group of early to mid-career researchers of the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), we propose some considerations in relation to over-the-counter availability of CBD and opportunities to improve knowledge about its potential therapeutic benefits alongside its increased uptake.
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Affiliation(s)
- Christine Mary Hallinan
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Edward Eden
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Myfanwy Graham
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | | | - Jessica Mills
- School of Psychology, Illawarra Health and Medical Research Institute (IHMRI), Faculty of the Arts Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Amirali Popat
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD, Australia
| | - Linda Truong
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Department of Neurology, Sydney Children's Hospital Randwick, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Yvonne Bonomo
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Addiction Medicine, St Vincent's Hospital Melbourne, VIC, Australia
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13
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Lehrer S, Rheinstein PH. Cannabis smoking and glaucoma in the UK Biobank cohort. J Fr Ophtalmol 2022; 45:423-429. [PMID: 35093258 PMCID: PMC9051914 DOI: 10.1016/j.jfo.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cigarette smoking is a well-known risk factor for primary open-angle glaucoma (POAG). Tobacco smoke contains a variety of chemicals, including nicotine, free radicals, and carbon monoxide, all of which can play a role in the development of POAG. Cannabis smoke, like tobacco smoke, contains a comparable variety of carcinogenic and toxic compounds. In the present study, we analyzed UK Biobank data to determine whether smoking cannabis, like cigarettes, might be related to POAG. METHODS Our analysis included all subjects with glaucoma and cannabis smoking information. Data processing was performed on Minerva, a Linux mainframe with Centos 7.6, at the Icahn School of Medicine at Mount Sinai. We used the UK Biobank Data Parser (ukbb parser), a python-based package that allows easy interfacing with the large UK Biobank dataset. Statistical analysis was performed with SPSS 25 and R. RESULTS Subjects who used cannabis 100 times or more were significantly younger (10years) when they developed glaucoma than subjects who never used cannabis. The effects of age (P<0.001) and cigarettes (P=0.014) on POAG incidence were significant, but the effect of cannabis use was not (P=0.662). The effect of cannabis use on age at glaucoma diagnosis was significant and unrelated to the effects on intraocular pressure or cigarette pack-years smoked. Analysis of intraocular pressure showed that mean pressures of subjects who used cannabis 11-100 times were significantly lower than those who took no cannabis. CONCLUSION Inhaling cannabis smoke is injurious to the eye, but in the case of glaucoma the manifestations are different from those of inhaled tobacco smoke. Cannabis reduces intraocular pressure but accelerates glaucoma development. Cannabis does not increase risk of glaucoma. Cigarette smoking increases risk of glaucoma and significantly accelerates glaucoma development. Apparently, early use of cannabis leads to the earlier development of glaucoma.
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Affiliation(s)
- S Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - P H Rheinstein
- Severn Health Solutions, Severna Park, Maryland, United States
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14
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Lessons for the clinical nephrologist: unexplained tacrolimus overdose in a kidney transplant patient. J Nephrol 2022; 35:1911-1913. [DOI: 10.1007/s40620-022-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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15
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Abstract
BACKGROUND Cigarette smoking is a well-known risk factor for cataract and other ailments, including heart disease, lung cancer, and chronic obstructive pulmonary disease. Cannabis smoke, like tobacco smoke, contains a comparable variety of carcinogenic and toxic compounds. PURPOSE In the present study, we analyzed UK Biobank data to determine whether smoking cannabis, like cigarettes, might be related to cataract. METHODS Our analysis included all UK Biobank subjects with cataracts and information on cannabis and cigarette smoking habits. The diagnosis of cataract was ascertained using the 10th Revision of the International Classification of Diseases (ICD10), H25. The age at diagnosis of cataract was obtained from UK Biobank data field 4700. Cannabis information was recorded in UK Biobank category 143, data field 20453, ever taken cannabis. RESULTS Subjects who used cannabis 11-100 times or more were significantly younger (4-5 years) when they developed cataract than subjects who never used cannabis. To determine the relationship of current cigarette smoking to cannabis use and age at cataract, the univariate general linear model of SPSS was used, dependent variable age at cataract, fixed factor cannabis use, random factor pack years of cigarettes smoked. Cannabis use was significantly related to age at cataract diagnosis (P<0.001) and independent of the effect of pack-years of cigarettes smoked (P=0.008). Linear regression revealed an insignificant relationship between pack-years of cigarette smoking and age at cataract diagnosis (P=0.073). To further evaluate the relationship of cannabis to cataract, propensity score matching was performed. We identified 28,432 subjects with cataract. Current cigarette smoking and age were covariates; cannabis use (yes/no) was the indicator variable. Current cigarette smoking was significantly associated with a 1.2 odds ratio for cataract. Cannabis use was not significantly associated with the odds ratio for cataract. CONCLUSION Like tobacco smoke, cannabis smoke contains thousands of organic and inorganic chemical compounds. Cannabis tar is chemically similar to tar found in tobacco smoke, and over fifty known carcinogens have been identified in cannabis smoke, including nitrosamines, reactive aldehydes, and polycyclic hydrocarbons. Thus, the association of cannabis with cataract that we report here is not entirely surprising. Further studies are warranted.
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Affiliation(s)
- S Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - P H Rheinstein
- Severn Health Solutions, Severna Park, Maryland, United States
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16
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Maguire RF, Wilkinson DJ, England TJ, O'Sullivan SE. The Pharmacological Effects of Plant-Derived versus Synthetic Cannabidiol in Human Cell Lines. Med Cannabis Cannabinoids 2022; 4:86-96. [PMID: 35224428 DOI: 10.1159/000517120] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/08/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Cannabidiol (CBD) can be isolated from Cannabis sativa L. or synthetically produced. The aim of this study was to compare the in vitro effects of purified natural and synthetic CBD to establish any pharmacological differences or superiority between sources. Methods Six purified samples of CBD were obtained, 4 of these were natural and 2 synthetic. The anticancer effects of CBD were assessed in a human ovarian cancer cell line (SKOV-3 cells). The neuroprotective effects of CBD were assessed in human pericytes in a model of stroke (oxygen glucose deprivation [OGD]). The ability of CBD to restore inflammation-induced intestinal permeability was assessed in differentiated human Caco-2 cells (a model of enterocytes). Results (1) In proliferating and confluent SKOV-3 cells, all CBD samples similarly reduced resazurin metabolism as a marker of cell viability in a concentration-dependent manner (p < 0.001). (2) In pericytes exposed to OGD, all CBD samples similarly reduced cellular damage (measured by lactate dehydrogenase) at 24 h by 31-48% and reduced inflammation (measured by IL-6 secretion) by 30-53%. Attenuation of IL-6 was inhibited by 5HT1A receptor antagonism for all CBD sources. (3) In differentiated Caco-2 cells exposed to inflammation (TNFα and IFNγ, 10 ng/mL for 24 h), each CBD sample increased the speed of recovery of epithelial permeability compared to control (p < 0.05-0.001), which was inhibited by a CB1 receptor antagonist. Conclusion Our results suggest that there is no pharmacological difference in vitro in the antiproliferative, anti-inflammatory, or permeability effects of purified natural versus synthetic CBD. The purity and reliability of CBD samples, as well as the ultimate pharmaceutical preparation, should all be considered above the starting source of CBD in the development of new CBD medicines.
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Affiliation(s)
- Ryan F Maguire
- Division of Graduate Entry Medicine and Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, United Kingdom
| | - Daniel J Wilkinson
- Division of Graduate Entry Medicine and Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, United Kingdom
| | - Timothy J England
- Division of Graduate Entry Medicine and Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, United Kingdom.,Department of Stroke, University Hospitals of Derby and Burton, Derby, United Kingdom
| | - Saoirse E O'Sullivan
- Division of Graduate Entry Medicine and Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, United Kingdom.,Artelo Biosciences, Inc., La Jolla, California, USA
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17
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Miller OS, Elder EJ, Jones KJ, Gidal BE. Analysis of cannabidiol (CBD) and THC in nonprescription consumer products: Implications for patients and practitioners. Epilepsy Behav 2022; 127:108514. [PMID: 34998268 DOI: 10.1016/j.yebeh.2021.108514] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Cannabidiol products remains largely unregulated in the US. Unlike the Rx formulation of CBD [EpidiolexR], little information is available regarding labeling accuracy (does the product contain what the label says it does), lot to lot variability, nor long-term product stability. Understanding these properties are fundamental if these products are to be used in patients with epilepsy, where product variability of traditional AEDs has been suspected to result in inadequate seizure control. Therefore, we analyzed commercial CBD products, including oils, aqueous products (i.e., beverages), and various Other products for cannabinoid content vs label claims and stability under United States Pharmacopeia (USP) standards. METHOD Samples were diluted and analyzed by HPLC for CBD, THC, and CBN concentrations in order to assess product label accuracy. Products with <90% of label claim CBD were denoted over-labeled, products with >110% of label claim CBD were denoted under-labeled, and products between 90% and 110% of label claim CBD were denoted appropriately labeled, per USP standards. RESULTS Among commercial CBD Oils (n = 11), mean CBD concentration vs label claim was 91.56% [95% CI, 66.02-117.10%], although 18.18% of oils (n = 2) made nonspecific label claims of "hemp extract" in lieu of CBD. Among all oils, 36.36% (n = 4) were appropriately labeled, another 36.4% (n = 4) of all oils were under-labeled, maximum 128.3% label claim, and finally, 9.09% (n = 1) of oils were over-labeled. The remaining 18.18% (n = 2) of oils lacked specific CBD label claims, minimum of 0.3 mg CBD per 1-ml "dose". THC was detected in 54.55% (n = 6) of oils with a maximum concentration of 0.2% w/v and a minimum concentration of 0.036% w/v. Cannabinol was detectable in only 9.1% (n = 1) of products at a concentration of 0.00465% w/v. Among aqueous products (n = 21) tested, only 66.67% (n = 14) gave specific CBD label claims, with mean CBD concentration vs label claim of 59.93% [95% CI, 38.24-81.63%]. Only 7.14% (n = 1) of aqueous products with a label claim were appropriately labeled, 14.29% (n = 2) were found to be under-labeled, and 78.57% (n = 11) over-labeled. THC was detected in 23.81% (n = 5) of aqueous products tested with a maximum THC concentration of 0.0005% w/v, and a minimum concentration of 0.0002% w/v. Cannabinol was detected in 9.52% (n = 2) of aqueous products, both at a concentration of 0.0015% w/v. "Other" products (n = 7) tested ranged from chocolate bars to transdermal patches. Some 42.86% (n = 3) gave specific CBD label claims, with mean CBD concentration vs label claim of 67.01% [95% CI, 0.87-133.14%]. Among these three "Other" products with specific label claims, 33% (n = 1) was appropriately labeled, and 66.67% (n = 2) were over-labeled, with CBD concentrations vs label claim ranging from a minimum of 39.30% to a maximum of 101.99%. The remaining 57.14% (n = 5) of "Other" products tested made nonspecific CBD label claims, denoting CBD content in terms of "full spectrum hemp extract" or "activated cannabinoids". One such product was labeled with a "40-50-mg CBD" range instead of a single, specific value. Tetrahydrocannabinol was detected in 71.43% (n = 5) of Other products tested with a maximum concentration of 0.0046% w/w, and a minimum concentration of 0.0008% w/w. Cannabinol was detected in 14.3% (n = 1) of Other products at a concentration of 0.0001% w/w. CONCLUSION We demonstrate that commercial CBD products, especially aqueous beverages, can show inconsistent labeling, vary largely from their label claims should they make them, and show lot-to-lot variability making dosing unpredictable.
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Affiliation(s)
- Owen S Miller
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
| | - Edmund J Elder
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States; University of Wisconsin - Zeeh Pharmaceutical Experiment Station, 777 Highland Ave, Madison, WI 53705-2222, United States.
| | - Karen J Jones
- University of Wisconsin - Zeeh Pharmaceutical Experiment Station, 777 Highland Ave, Madison, WI 53705-2222, United States.
| | - Barry E Gidal
- University of Wisconsin, School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States.
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18
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Suraev A, Benson MJ, Martin L, Lintzeris N, McGregor IS. Determination of contaminants in artisanal cannabis products used for childhood epilepsy in the Australian community: A sub-analysis of the 'PELICAN' study. Epilepsy Behav 2022; 127:108496. [PMID: 34954507 DOI: 10.1016/j.yebeh.2021.108496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/07/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
Despite recent approval of pharmaceutical-grade cannabis products for the treatment of childhood epilepsy, some families continue to use artisanal cannabis products as a way to manage seizures in their children. However, such products are typically of unknown composition and quality, and may therefore pose an unpredictable health risk to the child. In the present analysis, 78 samples of cannabis products collected (as part of a previous study) from families of children with epilepsy (average age 8.8 ± 4.6 years) were analyzed for heavy metals (arsenic, cadmium, lead, and mercury), residual solvents (panel of 19 solvents) and pesticides (panel of 57 pesticides). Due to small sample volumes obtained, only a subset of samples was used in each analysis. Results showed that no cannabis sample exceeded the toxicity limits for heavy metals (n = 51 samples tested). Of the 58 cannabis samples tested for residual solvents, 17 (29%) contained concentrations of ethanol or isopropanol above the generally accepted limit of 5000 parts per million. With the volumes consumed, it was thought unlikely that children were consuming hazardous amounts of residual solvents, although this could not be ruled out in every case. Most samples (n = 31 samples tested) yielded inconclusive results for the pesticides, although one sample contained concentrations of bifenthrin that were 4.9 times higher than the acceptable limit. Overall, these results highlight the need for improved access to quality-assured cannabis products and the education of doctors, patients, and artisanal manufacturers around the contaminant exposure risk in unregulated cannabis products.
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Affiliation(s)
- Anastasia Suraev
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia.
| | - Melissa J Benson
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia.
| | - Lewis Martin
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia.
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, Sydney, Australia; Division Addiction Medicine, Faculty Medicine and Health, Sydney, Australia; NSW DACRIN (Drug and Alcohol Clinical Research and Improvement Network), Sydney, Australia.
| | - Iain S McGregor
- The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Sydney, Australia; The University of Sydney, Brain and Mind Centre, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia.
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19
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Balthazar C, Joly DL, Filion M. Exploiting Beneficial Pseudomonas spp. for Cannabis Production. Front Microbiol 2022; 12:833172. [PMID: 35095829 PMCID: PMC8795690 DOI: 10.3389/fmicb.2021.833172] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022] Open
Abstract
Among the oldest domesticated crops, cannabis plants (Cannabis sativa L., marijuana and hemp) have been used to produce food, fiber, and drugs for thousands of years. With the ongoing legalization of cannabis in several jurisdictions worldwide, a new high-value market is emerging for the supply of marijuana and hemp products. This creates unprecedented challenges to achieve better yields and environmental sustainability, while lowering production costs. In this review, we discuss the opportunities and challenges pertaining to the use of beneficial Pseudomonas spp. bacteria as crop inoculants to improve productivity. The prevalence and diversity of naturally occurring Pseudomonas strains within the cannabis microbiome is overviewed, followed by their potential mechanisms involved in plant growth promotion and tolerance to abiotic and biotic stresses. Emphasis is placed on specific aspects relevant for hemp and marijuana crops in various production systems. Finally, factors likely to influence inoculant efficacy are provided, along with strategies to identify promising strains, overcome commercialization bottlenecks, and design adapted formulations. This work aims at supporting the development of the cannabis industry in a sustainable way, by exploiting the many beneficial attributes of Pseudomonas spp.
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Affiliation(s)
- Carole Balthazar
- Department of Biology, Faculty of Sciences, Université de Moncton, Moncton, NB, Canada
| | - David L. Joly
- Department of Biology, Faculty of Sciences, Université de Moncton, Moncton, NB, Canada
| | - Martin Filion
- Saint-Jean-sur-Richelieu Research and Development Centre, Agriculture and Agri-Food Canada, Saint-Jean-sur-Richelieu, QC, Canada
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20
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Park SH, Pauli CS, Gostin EL, Staples SK, Seifried D, Kinney C, Vanden Heuvel BD. Effects of short-term environmental stresses on the onset of cannabinoid production in young immature flowers of industrial hemp (Cannabis sativa L.). J Cannabis Res 2022; 4:1. [PMID: 34980266 PMCID: PMC8725245 DOI: 10.1186/s42238-021-00111-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUNDS Cannabis sativa L. produces at least 120 cannabinoids. Although genetic variation is the main factor in cannabinoid production, the effects of short-term environmental stresses in the early flowering stage remains largely unknown. METHODS To investigate the effects of short-term environmental stresses on the onset of cannabinoid production in young immature flowers, a hemp variety, Green-Thunder (5-8% CBD/mg of dry weight), was treated with mechanical damage, insect herbivory, extreme heat, or drought stress for 5-7 days during the first 2 weeks of flowering. Three hemp tissues, including flowers, leaves, and stems, were collected from hemp grown under these stress conditions at multiple time points during the first 2 weeks after transition to the short photoperiod and analyzed using high pressure liquid chromatography to quantify phytocannabinoids including cannabigerolic acid (CBGA), cannabigerol (CBG), cannabidiolic acid (CBDA), cannabidiol (CBD), Δ-tetrahydrocannabinolic acid (THCA), Δ-tetrahydrocannabinol (THC), and cannabinol (CBN). RESULTS The 5 days of mechanical wounding did not affect the production of any of the cannabinoids during the initial stage of flowering. However, after 5 days of herbivore treatment, there was a significant difference in concentration between day 1 and day 6 of CBGA (control: 308 μg/g; treatment - 24 μg/g), CBG (control: 69 μg/g; treatment: 52 μg/g), and CBD (control: 755 μg/g; treatment: 194 μg/g) between the control and treatment plants. The 7 days of heat treatment at 45-50 oC significantly reduced the production of CBGA during this observed window (control: 206 μg/g; treatment: 182 μg/g) and CBG (control: 21 μg/g; treatment: - 112 μg/g). Notably, the largest change was observed after 7 days of drought stress, when plants showed a 40% greater accumulation of CBG (control: 336 μg/g; treatment: 622 μg/g), and a significant decrease (70-80%) in CBD (control: 1182 μg/g; treatment: 297 μg/g) and THC amounts (control: 3927 μg/g; treatment: 580 μg/g). CONCLUSIONS Although this observation is limited in the early flowering stage, the common field stresses are adequate to induce changes in the cannabinoid profiles, particularly drought stress being the most impactful stress for hemp flower initiation with the altering the cannabinoid production by decreasing CBD and THC accumulation while increasing CBG by 40%.
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Affiliation(s)
- Sang-Hyuck Park
- Institute of Cannabis Research, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA.
- Department of Biology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA.
| | - Christopher S Pauli
- Institute of Cannabis Research, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
| | - Eric L Gostin
- Department of Biology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
| | - S Kyle Staples
- Department of Biology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
| | - Dustin Seifried
- Department of Chemistry, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
| | - Chad Kinney
- Institute of Cannabis Research, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
- Department of Chemistry, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
| | - Brian D Vanden Heuvel
- Department of Biology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA
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21
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Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia. THE JOURNAL OF PAIN 2022; 23:45-54. [PMID: 34214700 PMCID: PMC8716664 DOI: 10.1016/j.jpain.2021.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
Many people with fibromyalgia use cannabidiol (CBD) products despite limited rigorous evidence of benefit. In the current study, we conducted a secondary analysis of a cross-sectional survey of N = 878 people with fibromyalgia to investigate naturalistic decision making around CBD product choices, use patterns, and dosing. We subgrouped participants based on use of high-THC cannabis (HTC) in the past year (yes/no) as previous studies have shown that HTC use influences CBD use patterns. The study population was largely female (93.6%), white (91.5%) and 55.5 years old on average. Participants typically purchased CBD products online or at dispensaries, with purchasing driven by personal research (63%) rather than endorsement from medical professionals (16%). Overall, tinctures and topicals were the most common administration routes endorsed. However, participants in the past-year HTC group used inhalation routes far more frequently than those who did not (39.8% vs 7.1%). Among participants using CBD tinctures or edibles, the average dose per session was 16 mg and 24 to 27 mg per day, although approximately one-third of participants did not know what dose of CBD they used. Participants using both inhalation and non-inhalation administration routes reported greater symptom relief than those using non-inhalation routes alone. However, there was no consistent relationship between CBD dose and reported effects, possibly due to expectancy effects around CBD products or interindividual variability. Our granular investigation reveals variability of CBD product dosing practices for fibromyalgia, and how past-year HTC use influences CBD product use. Future clinical trials should investigate the potential benefits of low-dose (<50mg) botanical CBD products. PERSPECTIVE: This article shows that past-year HTC use strongly influences how people with fibromyalgia choose and use CBD products. Participants typically used <50 mg/d of CBD, and there was no relationship between higher CBD dose and reported therapeutic benefit. Future clinical trials should investigate therapeutic benefits of low dose CBD.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA,Corresponding author: Kevin Boehnke, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106.
| | - Joel J. Gagnier
- Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David A. Williams
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
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22
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López-Ruiz R, Marín-Sáez J, Garrido Frenich A, Romero-González R. Recent applications of chromatography for analysis of contaminants in cannabis products: a review. PEST MANAGEMENT SCIENCE 2022; 78:19-29. [PMID: 34390132 DOI: 10.1002/ps.6599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/04/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
In the last few years, the cultivation of cannabis has been increasing due to greater use in foods, recreational use, creams, oils, and other applications. Thus, analysis of contaminants (e.g. pesticides and mycotoxins) in cannabis products is necessary to ensure consumer safety. This review is focused on the analytical procedures, based on chromatographic techniques, used for the determination of contaminants in cannabis and related products, developed from 2015 to 2020. QuEChERS (acronym of quick, easy, cheap, effective, rugged and safe) was mainly used for the extraction of pesticides and other contaminants from cannabis because its versatility and capacity to extract a wide range of substances, and therefore, increasing the scope of the analysis. The most employed technique to determine pesticides and mycotoxins in cannabis products was liquid chromatography (LC) coupled to mass spectrometry (MS), although gas chromatography (GC) coupled to MS was also employed for the analysis of non-polar compounds, using triple quadrupole (QqQ) as mass analyzer. Nevertheless, new advances in cannabis analysis are also discussed, introducing techniques such as high-resolution mass spectrometry (HRMS), which allows for performing both targeted and untargeted (unknown and suspect) analyses. © 2021 Society of Chemical Industry.
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Affiliation(s)
- Rosalía López-Ruiz
- Research Group 'Analytical Chemistry of Contaminants', Department of Chemistry and Physics, Research Centre for Mediterranean Intensive Agrosystems and Agri-Food Biotechnology (CIAIMBITAL), University of Almeria, Agrifood Campus of International Excellence, Almeria, Spain
| | - Jesús Marín-Sáez
- Research Group 'Analytical Chemistry of Contaminants', Department of Chemistry and Physics, Research Centre for Mediterranean Intensive Agrosystems and Agri-Food Biotechnology (CIAIMBITAL), University of Almeria, Agrifood Campus of International Excellence, Almeria, Spain
| | - Antonia Garrido Frenich
- Research Group 'Analytical Chemistry of Contaminants', Department of Chemistry and Physics, Research Centre for Mediterranean Intensive Agrosystems and Agri-Food Biotechnology (CIAIMBITAL), University of Almeria, Agrifood Campus of International Excellence, Almeria, Spain
| | - Roberto Romero-González
- Research Group 'Analytical Chemistry of Contaminants', Department of Chemistry and Physics, Research Centre for Mediterranean Intensive Agrosystems and Agri-Food Biotechnology (CIAIMBITAL), University of Almeria, Agrifood Campus of International Excellence, Almeria, Spain
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23
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Weiss MC, Hibbs JE, Buckley ME, Danese SR, Leitenberger A, Bollmann-Jenkins M, Meske SW, Aliano-Ruiz KE, McHugh TW, Larson SL, Le EH, Green NL, Gilman PB, Kaklamani VG, Chlebowski RT, Martinez DM. A Coala-T-Cannabis Survey Study of breast cancer patients' use of cannabis before, during, and after treatment. Cancer 2022; 128:160-168. [PMID: 34636036 PMCID: PMC9413357 DOI: 10.1002/cncr.33906] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/16/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of this study was to characterize cannabis use among patients with breast cancer, including their reasons for and timing of use, their sources of cannabis information and products, their satisfaction with the information found, their perceptions of its safety, and their dialogue about cannabis with their physicians. METHODS United States-based members of the Breastcancer.org and Healthline.com communities with a self-reported diagnosis of breast cancer within 5 years (age ≥ 18 years) were invited to participate in an anonymous online survey. After informed consent was obtained, nonidentifiable data were collected and analyzed. RESULTS Of all participants (n = 612), 42% (n = 257) reported using cannabis for relief of symptoms, which included pain (78%), insomnia (70%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Furthermore, 49% of cannabis users believed that medical cannabis could be used to treat cancer itself. Of those taking cannabis, 79% had used it during treatment, which included systemic therapies, radiation, and surgery. At the same time, few (39%) had discussed it with any of their physicians. CONCLUSIONS A significant percentage of survey participants (42%) used cannabis to address symptoms; approximately half of these participants believed that cannabis could treat cancer itself. Most participants used cannabis during active cancer treatment despite the potential for an adverse event during this vulnerable time. Furthermore, most participants believed that cannabis was safe and were unaware that product quality varied widely and depended on the source. This study reviews the research on medicinal cannabis in the setting of these findings to help physicians to recognize its risks and benefits for patients with cancer. LAY SUMMARY Almost half of patients with breast cancer use cannabis, most commonly during active treatment to manage common symptoms and side effects: pain, anxiety, insomnia, and nausea. However, most patients do not discuss cannabis use with their physicians. Instead, the internet and family/friends are the most common sources of cannabis information. Furthermore, most participants believe that cannabis products are safe and are unaware that the safety of many products is untested.
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Affiliation(s)
- Marisa C. Weiss
- Breastcancer.org, Ardmore, Pennsylvania,Socanna, Narberth, Pennsylvania,Radiation Oncology, Lankenau Medical Center, Wynnewood, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Meghan E. Buckley
- Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | | | - Sam W. Meske
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania,Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | - Sharon L. Larson
- Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | - Paul B. Gilman
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Virginia G. Kaklamani
- Medical Oncology, Internal Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Rowan T. Chlebowski
- Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Diana M. Martinez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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24
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Goldman S, Bramante J, Vrdoljak G, Guo W, Wang Y, Marjanovic O, Orlowicz S, Di Lorenzo R, Noestheden M. The analytical landscape of cannabis compliance testing. J LIQ CHROMATOGR R T 2021. [DOI: 10.1080/10826076.2021.1996390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Julia Bramante
- Cannabis Sciences Program, Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Gordon Vrdoljak
- Department of Cannabis Control, Cannabis Testing Laboratory Branch, Richmond, CA, USA
| | - Weihong Guo
- Department of Cannabis Control, Cannabis Testing Laboratory Branch, Richmond, CA, USA
| | - Yun Wang
- Department of Cannabis Control, Cannabis Testing Laboratory Branch, Richmond, CA, USA
| | - Olivera Marjanovic
- Department of Cannabis Control, Cannabis Testing Laboratory Branch, Richmond, CA, USA
| | | | | | - Matthew Noestheden
- SCIEX, Concord, Canada
- Department of Chemistry, University of British Columbia Okanagan, Kelowna, Canada
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25
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Serafimovska T, Stefanovski S, Erler J, Keskovski Z, Stefkov G, Mitevska M, Darkovska Serafimovska M, Balkanov T, Tonic Ribarska J. Does Cannabis Extract Obtained From Cannabis Flowers With Maximum Allowed Residual Level of Aflatoxins and Ochratoxin a Have an Impact on Human Safety and Health? Front Med (Lausanne) 2021; 8:759856. [PMID: 34869462 PMCID: PMC8634097 DOI: 10.3389/fmed.2021.759856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: The aim of this study was to investigate whether the cannabis extract obtained from cannabis flowers that contain the maximum allowed level of mycotoxins affects human safety and health. For that purpose, a novel liquid chromatography with tandem mass spectrometry (LC/MS/MS) method was developed and validated for the determination of aflatoxins and ochratoxin A (OchA) in cannabis extracts to demonstrate that this analytical method is suitable for the intended experimental design. Methods: Experimental design was done by adding maximum allowed concentration of aflatoxins (B1, B2, G1, G2) and OchA according to the European Pharmacopeia related to cannabis flowers. The concentration of aflatoxins and OchA was determined using the same LC/MS/MS analytical method in the starting material (dry flower) before preparing the spiked sample and after obtaining decarboxylated extract with ethanol 96%. Results: The results obtained indicate that aflatoxins and OchA, primarily added to the cannabis dried flowers, were also determined into the obtained final extract in amounts much higher (m/m) than in the starting plant material. Conclusion: With this experiment, we have shown that mycotoxins, especially aflatoxins, which are extremely toxic secondary metabolites, can reach critical values in cannabis extracts obtained from dry cannabis flowers with the maximum allowed quantity of mycotoxins. This can pose a great risk to consumers and their health especially to those with compromised immune systems.
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Affiliation(s)
- Tijana Serafimovska
- Faculty of Pharmacy, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Sasho Stefanovski
- NYSK Holdings, Company for Growing, Extraction and Producing of Pharmaceutical Dosage Forms of Medical Cannabis, Skopje, North Macedonia
| | | | - Zlatko Keskovski
- NYSK Holdings, Company for Growing, Extraction and Producing of Pharmaceutical Dosage Forms of Medical Cannabis, Skopje, North Macedonia
| | - Gjoshe Stefkov
- Faculty of Pharmacy, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Marija Mitevska
- NYSK Holdings, Company for Growing, Extraction and Producing of Pharmaceutical Dosage Forms of Medical Cannabis, Skopje, North Macedonia
| | | | - Trajan Balkanov
- Department of Pharmacology and Toxicology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
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26
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Cohn AM, Blount BC, Hashibe M. Nonmedical Cannabis Use: Patterns and Correlates of Use, Exposure, and Harm, and Cancer Risk. J Natl Cancer Inst Monogr 2021; 2021:53-67. [PMID: 34850898 DOI: 10.1093/jncimonographs/lgab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Cannabis has certain health benefits, but some people may experience harms from use. Co-use of tobacco and cannabis is common. Smoke from cannabis contains many of the same carcinogens and toxicants as the smoke from tobacco, raising concerns that cannabis smoking may be a risk factor for cancer. With growing access to and acceptance of medical and nonmedical cannabis, there is an urgent need to understand the risks and benefits of the current modes of cannabis use and how cannabis may be associated with cancer risk. This monograph summarizes a session from a National Cancer Institute Symposium on nonmedical cannabis use and cancer risk. We had 3 objectives: describe the relation between nonmedical cannabis use and cancer risk, delineate patterns and correlates of cannabis co-use with tobacco, and document potentially harmful inhalational exposure resulting from smoked and vaped cannabis. Methodological limitations in the literature and future research recommendations are provided.
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Affiliation(s)
- Amy M Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Stephenson Center, Oklahoma City, OK, USA.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT, USA
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27
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Kanabus J, Bryła M, Roszko M, Modrzewska M, Pierzgalski A. Cannabinoids-Characteristics and Potential for Use in Food Production. Molecules 2021; 26:6723. [PMID: 34771132 PMCID: PMC8588477 DOI: 10.3390/molecules26216723] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Scientific demonstrations of the beneficial effects of non-psychoactive cannabinoids on the human body have increased the interest in foods containing hemp components. This review systematizes the latest discoveries relating to the characteristics of cannabinoids from Cannabis sativa L. var. sativa, it also presents a characterization of the mentioned plant. In this review, we present data on the opportunities and limitations of cannabinoids in food production. This article systematizes the data on the legal aspects, mainly the limits of Δ9-THC in food, the most popular analytical techniques (LC-MS and GC-MS) applied to assay cannabinoids in finished products, and the available data on the stability of cannabinoids during heating, storage, and access to light and oxygen. This may constitute a major challenge to their common use in food processing, as well as the potential formation of undesirable degradation products. Hemp-containing foods have great potential to become commercially popular among functional foods, provided that our understanding of cannabinoid stability in different food matrices and cannabinoid interactions with particular food ingredients are expanded. There remains a need for more data on the effects of technological processes and storage on cannabinoid degradation.
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Affiliation(s)
- Joanna Kanabus
- Department of Food Safety and Chemical Analysis, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, Rakowiecka 36, 02-532 Warsaw, Poland; (M.B.); (M.R.); (M.M.); (A.P.)
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28
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Fischer B, Lee A, Robinson T, Hall W. An overview of select cannabis use and supply indicators pre- and post-legalization in Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:77. [PMID: 34620191 PMCID: PMC8496143 DOI: 10.1186/s13011-021-00405-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
Background Canada implemented the legalization and regulation of non-medical cannabis use, production and sale in 2018 aiming to improve public health and safety. While outcomes from legalization reforms in other jurisdictions mostly rely on US-based data have been assessed to be mixed, Canadian data are only emerging. We compiled select population-level data on key indicators to gauge initial developments from pre- to post-legalization of cannabis in Canada. Methods We examined indicators data focusing on the following topics: prevalence of cannabis use, frequency of use, methods/products of consumption, driving after cannabis use, and cannabis sourcing. Indicator data were obtained mostly from national and some provincial population surveys. Prevalence or percentages for the indicators pre- and post-legalization (e.g., 2017- 2020), including confidence intervals were reported, with changes noted, as available in and indicated by the data sources. Results Data suggested selected increases in cannabis use prevalence, mostly among mid- and older- but possibly also younger (e.g., under legal use age) users. Frequency of use and driving after cannabis use among active users do not appear to have changed. Methods of cannabis use show diversifying trends, with decreases in smoking and increases in alternatives use modes (e.g., edibles, vaping). There is a clearly increasing trend towards accessing cannabis from legal sources among adults, while under-legal-use-age youth do not appear to experience heightened barriers to obtaining cannabis in legalization contexts. Conclusions Preliminary indicators on cannabis legalization in Canada show a mixed picture, some similar to US-based developments. While some use increases are observed, these do not necessarily represent indications of increases in cannabis-related harm, also since key (e.g., hospitalization or injury) data are lacking to date. There is a gradual embracing of legal supply sources of cannabis among users, which can be expected to serve public health and safety objectives. At the same time, cannabis use and access among under-age users as a principally vulnerable group do not appear to be hindered or reduced by legalization.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Department of Psychiatry, Federal University of São Paulo (UNIFESP), R. Dr. Ovídio Pires de Campos, São Paulo, 785 05403-90, Brazil.
| | - Angelica Lee
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada.,Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wayne Hall
- Centre for Youth Substance Abuse Research (CYSAR), 19 Upland Rd, St. Lucia, Queensland, 4072, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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29
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Brown JD, Rivera Rivera KJ, Hernandez LYC, Doenges MR, Auchey I, Pham T, Goodin AJ. Natural and Synthetic Cannabinoids: Pharmacology, Uses, Adverse Drug Events, and Drug Interactions. J Clin Pharmacol 2021; 61 Suppl 2:S37-S52. [PMID: 34396558 DOI: 10.1002/jcph.1871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/01/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this narrative review is to describe the current use environment of both natural and synthetic cannabinoids while providing context for cannabinoid chemistry and pharmacology. In addition to a long history of recreational and nonmedical use, natural cannabinoids are increasingly used as prescription products, through medical cannabis programs, and as consumer health products. Despite anecdotal safety evidence, cannabis and cannabinoids are pharmacologically complex and pose risks for adverse drug events and drug-drug interactions. Synthetic cannabinoids, particularly agonists of cannabinoid receptors, are more potent than natural cannabinoids and can lead to more severe reactions and medical emergencies. This review provides a summary of approved uses and an overview of mechanisms of action for adverse drug events with natural and synthetic cannabinoids. Clinical considerations for special populations that may be at heightened risk for drug-drug interactions and adverse drug events while using natural or synthetic cannabinoids are examined, and recommendations are provided.
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Affiliation(s)
- Joshua D Brown
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | | | | | - Matthew R Doenges
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - India Auchey
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Thanh Pham
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Amie J Goodin
- Center for Drug Evaluation & Safety, University of Florida, Gainesville, Florida, USA.,Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
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30
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Pinkhasova DV, Jameson LE, Conrow KD, Simeone MP, Davis AP, Wiegers TC, Mattingly CJ, Leung MCK. Regulatory Status of Pesticide Residues in Cannabis: Implications to Medical Use in Neurological Diseases. Curr Res Toxicol 2021; 2:140-148. [PMID: 34308371 PMCID: PMC8296824 DOI: 10.1016/j.crtox.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Movement disorders are the most common neurological category of qualifying conditions in the U.S. The number and action levels of regulated pesticides in cannabis differ vastly in 33 states and Washington, D.C. Network analysis reveals potential interactions of insecticides, cannabinoids, and seizure at a functional level.
Medical cannabis represents a potential route of pesticide exposure to susceptible populations. We compared the qualifying conditions for medical use and pesticide testing requirements of cannabis in 33 states and Washington, D.C. Movement disorders were the most common neurological category of qualifying conditions, including epilepsy, certain symptoms of multiple sclerosis, Parkinson’s Disease, and any cause of symptoms leading to seizures or spasticity. Different approaches of pesticide regulation were implemented in cannabis and cannabis-derived products. Six states imposed the strictest U.S. EPA tolerances (i.e. maximum residue levels) for food commodities on up to 400 pesticidal active ingredients in cannabis, while pesticide testing was optional in three states. Dimethomorph showed the largest variation in action levels, ranging from 0.1 to 60 ppm in 5 states. We evaluated the potential connections between insecticides, cannabinoids, and seizure using the Comparative Toxicogenomics Database. Twenty-two insecticides, two cannabinoids, and 63 genes were associated with 674 computationally generated chemical-gene-phenotype-disease (CGPD) tetramer constructs. Notable functional clusters included oxidation-reduction process (183 CGPD-tetramers), synaptic signaling pathways (151), and neuropeptide hormone activity (46). Cholinergic, dopaminergic, and retrograde endocannabinoid signaling pathways were linked to 10 genetic variants of epilepsy patients. Further research is needed to assess human health risk of cannabinoids and pesticides in support of a national standard for cannabis pesticide regulations.
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Affiliation(s)
- Dorina V Pinkhasova
- School of Mathematical and Natural Sciences, Arizona State University - West Campus, Glendale, AZ 85306.,Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Laura E Jameson
- Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Kendra D Conrow
- Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Michael P Simeone
- ASU Library Data Science and Analytics, Arizona State University, Tempe, AZ 85281
| | - Allan Peter Davis
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695
| | - Thomas C Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695
| | - Carolyn J Mattingly
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695
| | - Maxwell C K Leung
- School of Mathematical and Natural Sciences, Arizona State University - West Campus, Glendale, AZ 85306.,Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
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31
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Peng H, Shahidi F. Cannabis and Cannabis Edibles: A Review. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:1751-1774. [PMID: 33555188 DOI: 10.1021/acs.jafc.0c07472] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cannabis is an excellent natural source of fiber and various bioactive cannabinoids. So far, at least 120 cannabinoids have been identified, and more novel cannabinoids are gradually being unveiled by detailed cannabis studies. However, cannabinoids in both natural and isolated forms are especially vulnerable to oxygen, heat, and light. Therefore, a diversity of cannabinoids is associated with their chemical instability to a large extent. The research status of structural conversion of cannabinoids is introduced. On the other hand, the use of drug-type cannabis and the phytocannabinoids thereof has been rapidly popularized and plays an indispensable role in both medical therapy and daily recreation. The recent legalization of edible cannabis further extends its application into the food industry. The varieties of legal edible cannabis products in the current commercial market are relatively monotonous due to rigorous restrictions under the framework of Cannabis Regulations and infancy of novel developments. Meanwhile, patents/studies related to the safety and quality assurance systems of cannabis edibles are still rare and need to be developed. Furthermore, along with cannabinoids, many phytochemicals such as flavonoids, lignans, terpenoids, and polysaccharides exist in the cannabis matrix, and these may exhibit prebiotic/probiotic properties and improve the composition of the gut microbiome. During metabolism and excretion, the bioactive phytochemicals of cannabis, mostly the cannabinoids, may be structurally modified during enterohepatic detoxification and gut fermentation. However, the potential adverse effects of both acute and chronic exposure to cannabinoids and their vulnerable groups have been clearly recognized. Therefore, a comprehensive understanding of the chemistry, metabolism, toxicity, commercialization, and regulations regarding cannabinoid edibles is reviewed and updated in this contribution.
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Affiliation(s)
- Han Peng
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
| | - Fereidoon Shahidi
- Department of Biochemistry Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3X9
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32
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Lowe H, Steele B, Bryant J, Fouad E, Toyang N, Ngwa W. Antiviral Activity of Jamaican Medicinal Plants and Isolated Bioactive Compounds. Molecules 2021; 26:molecules26030607. [PMID: 33503834 PMCID: PMC7865499 DOI: 10.3390/molecules26030607] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023] Open
Abstract
Plants have had historical significance in medicine since the beginning of civilization. The oldest medical pharmacopeias of the African, Arabian, and Asian countries solely utilize plants and herbs to treat pain, oral diseases, skin diseases, microbial infections, multiple types of cancers, reproductive disorders among a myriad of other ailments. The World Health Organization (WHO) estimates that over 65% of the world population solely utilize botanical preparations as medicine. Due to the abundance of plants, plant-derived medicines are more readily accessible, affordable, convenient, and have safer side-effect profiles than synthetic drugs. Plant-based decoctions have been a significant part of Jamaican traditional folklore medicine. Jamaica is of particular interest because it has approximately 52% of the established medicinal plants that exist on earth. This makes the island particularly welcoming for rigorous scientific research on the medicinal value of plants and the development of phytomedicine thereof. Viral infections caused by the human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2), hepatitis virus B and C, influenza A virus, and the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) present a significant global burden. This is a review of some important Jamaican medicinal plants, with particular reference to their antiviral activity.
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Affiliation(s)
- Henry Lowe
- Biotech R & D Institute, University of the West Indies, Mona, 99999 Kingston, Jamaica; (H.L.); (J.B.)
- Vilotos Pharmaceuticals Inc., Baltimore, MD 21202, USA;
- Flavocure Biotech Inc., Baltimore, MD 21202, USA
- Institute of Human Virology (IHV), University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Blair Steele
- Biotech R & D Institute, University of the West Indies, Mona, 99999 Kingston, Jamaica; (H.L.); (J.B.)
- Correspondence: ; Tel.: +1-876-926-8502
| | - Joseph Bryant
- Biotech R & D Institute, University of the West Indies, Mona, 99999 Kingston, Jamaica; (H.L.); (J.B.)
| | - Emadelden Fouad
- Physics Department, Florida Polytechnic Institute, Lakeland, FL 33805, USA; (E.F.); (W.N.)
| | - Ngeh Toyang
- Vilotos Pharmaceuticals Inc., Baltimore, MD 21202, USA;
- Flavocure Biotech Inc., Baltimore, MD 21202, USA
| | - Wilfred Ngwa
- Physics Department, Florida Polytechnic Institute, Lakeland, FL 33805, USA; (E.F.); (W.N.)
- Brigham and Women’s Hospital, Dana-Faber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
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Abstract
In the context of urban land-use growth and the consequent impacts on the environment, green spaces provide ecosystem services for human health. The ecosystem services concept synthesises human–environmental interactions through a series of combined components of biodiversity and abiotic elements, linking ecological processes and functions. The concept of green infrastructure (GI) in the urban context emphasises the quality and quantity of urban and peri-urban green spaces and natural areas. In dense urban contexts, the applications of GI are limited and not applied to the potential urban spaces such as roofs and gardens. Often, roofs are characterised by impermeable paved surfaces with negative effects on human well-being, whereas garden designs do not consider social needs and environmental interactions. The role of urban stressors or the urban context as a driving force or pressure of urban green space is not always well understood and employed in the planning of green spaces. This is partly due to a knowledge gap between different science disciplines that operate on different scales, from single processes of the plants (which focus on plant responses to environmental stresses affecting human well-being) to urban ecosystems (which focus on the biodiversity and urban space planning–human well-being relationship). This can create a paradox, as green spaces that are not adequately designed might not produce the expected effects. In this paper, an overview of benefits and limitations of applying the ecosystem services approach when designing green spaces is presented. The focus is on the main urban ecosystem services provided by green roofs and community gardens such as GI that can represent strategies to provide ecological and social multifunctionality to waterproofed surfaces connected to the buildings and low-exploited gardens being the main areas that affect dense urban settlements, and thus, increasing the ecosystem services in the urban environment, such as reducing the Urban Heat Island, as well as flooding events. Specifically, the paper highlights (i) feedback between ecological processes and functions that support ecosystem services, (ii) urban environmental stresses in relation to disservices that these can create for human well-being and (iii) key issues that should be considered in the planning and design of urban ecosystem services. Such a new vision of urban ecosystem services highlights the need to look at GI as an active part of the urban space design in the built environment.
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Dhondt F, Muthu SS. Sustainable Hemp Products. SUSTAINABLE TEXTILES: PRODUCTION, PROCESSING, MANUFACTURING & CHEMISTRY 2021:95-107. [DOI: 10.1007/978-981-16-3334-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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